The human eye is protected by two types of tears--constant tears from the small glands of Krause and Wolfring in the upper eyelid containing lysozyme and other components, and reflex tears from the main lacrimal gland, that are basically saline. The constant tears are multi-layered to fulfill their lubricating and sanitizing functions while the reflex tears wash or flood the eye to cleanse away foreign objects and additionally provide emotional relief.
Many people suffer from what is called "dry eye", a condition wherein the eye evidences such conditions an conjunctivitis, corneal ulcers, recurrent chalazion, pterygium, chronic blepharitis and problems stemming from wearing soft contact lenses. Dry eye, or kerato-conjunctivitis sicca, has also been discovered to be a factor in recurrent colds, sinus problems and hay fever symptoms because of the close association of the punctum canaliculi and the fluid systems involved in the recited problems.
The work of Tuberville, Fredrick and Wood was reported in 1981 and their reports, relating the results of punctal occlusion by cauterization were positive, but eight of the thirty two cauterized reopened within a short while after the occlusion treatment. This factor discouraged professional followup on the procedure.
Surgical closing of the punctum with fine sutures also proved to be a temporary measure, the stitches being absorbed in seven or eight days after surgery. It was also found that cauterization often enlarged the canaliculus opening after the initial treatment, causing not a retraction of the tissues around the punctal opening but actual increase in opening size due to the destruction of surrounding tissue during cautery. Thus, the failure rate for the intended permanent occlusion was very high.
I have discovered that whole or partial occlusion of the upper and lower punctum has direct bearing on the external eye conditions set forth above, as well as upon the symptomatic involvement of associated areas such as sinus passages, nasal passages and inner ear. By employing a temporary stitch test, not as a traditional treatment, but as a diagnostic step, and employing the energy of a laser beam in controlled phases upon the tissue in the punctal area, I am able to achieve desired occlusion of the punctum that is not only of desired permanence but which may be reversed if necessary.